The Health and Care Act 2022 is a major piece of legislation seeking to reform the delivery and organisation of health services in the UK. It seeks to promote more joined up services and collaboration connecting health systems with all communities, particularly marginalised communities, to reduce health inequality and improve access to all health care services for all patients.

There has been a particular focus on the new integrated care partnerships and integrated care boards and the need for embedding local clinical leadership by clinicians who understand the day-to-day work in public health and social care. I, however, discuss the powers given under the Act to abolish professional healthcare regulatory bodies, which regulate individual healthcare professionals by setting professional standards in education, training and expected behaviours, and how this may impact healthcare professionals undergoing fitness to practise investigations.

Too many regulators 

The Act follows the March 2021 consultation on regulating healthcare professionals supported by all four UK governments. Currently, there are 32 healthcare professions regulated by nine independent regulators. They are the General Chiropractic Council, the General Dental Council, the General Medical Council, the General Optical Council, the General Osteopathic Council, the General Pharmaceutical Council, the Health and Care Professions Council, the Nursing Midwifery Council and the Pharmaceutical Society of Northern Ireland. 

It’s been suggested that there is no rationale for having nine different healthcare regulatory bodies, although each regulator focuses specifically on the needs and expertise of their professional registrants. The Health and Care Professions Council “HCPC”, for example, regulates 15 different health and care professions.

The hope is that in reducing the number of regulators, this will save money, make it easier for people to know who to complain to, bring greater consistency about standards expected and achieve more consistency in the outcomes of cases where more than one healthcare professional is involved.

The HCPC reported that over a sample period of 18 months between 2012 and 2013 in which cases were opened and closed before March 2014, their overall costs, including legal fees and venue costs for fitness to practise investigations, came to approximately £19.7 million. Most complaints were referred by employers.

Better training on codes of conduct

It is expected that professional regulators will also work more closely in partnership with employers and higher education providers and will provide more training and teaching to identify behavioural problems early in a professional’s career to avoid future investigations. This is all very commendable, but it's a big ask of the regulators. I agree the regulators need to do more, particularly in raising awareness about their codes of conduct and breaches of the codes which lead to fitness to practise investigations. 

Healthcare professionals who often end up in front of fitness to practise investigations are either unfamiliar with their codes of practice or sometimes believe that, because they are clinically competent and an asset to an already struggling department, they shouldn’t be sanctioned for matters such as inflating their CV or for unprofessional behaviour inside or outside of the workplace.

 Although the idea of reducing the number of regulators might benefit the regulators and save them money, it’s unclear how these changes will resolve the issues faced by healthcare professionals working on the ground where problems usually arise first.

A good example of this is the Gosport inquiry, which looked at the Gosport War Memorial hospital, where nurses had raised concerns about the overprescribing of diamorphine to elderly patients resulting in excess deaths. There were failings here by the Trust to investigate these issues. Also, consider Furness General Hospital maternity ward, where failings were identified in the quality of the midwifery investigations into mother and baby deaths. Although the NMC was criticised for the way in which it handled its fitness to practise investigations and for the way in which it treated the bereaved families, the regulators are not the healthcare provider or the employers of the healthcare professional. 

Local level reform is key 

The regulators can't undertake serious untoward incident investigations themselves, as they aren’t in a position to speak to the healthcare professionals at the time of the event, nor can they make organisational changes or resolve interdepartmental issues within healthcare settings. They are primarily concerned with their registrants’ fitness to practise and usually look at the issues long after the events in question.

Organisational changes by the healthcare providers are needed at local level to avoid scandals like the ones mentioned above. Reducing the number of professional regulators won’t resolve these issues. The problem is, however, whether there are enough healthcare staff and resources to make the changes required. The BMA and others argue the Act does not address the issue of chronic staff shortages. Some healthcare professionals have also voiced that it does not address bullying and blame in the workforce.  These are ground level issues which need to be addressed in order for the aims of the Act to be successful.
 Deepika Raino, Director and Head of Professional Regulation and Healthcare at Adkirk Law